Airway obstruction during general anesthesia in a premature infant suspecting bronchospasm and/or airway malacia: A case report

Airway management is challenging during general anesthesia particularly in small infants. Airway obstruction is prone to occur in premature infants during general anesthesia due to several reasons. We report a case of airway obstruction occurred during the induction of general anesthesia in a 2-month-old infant. Several attempts at endotracheal intubation with positive pressure ventilation resulted in repeated patterns of no end-tidal carbon dioxide output after each trial of endotracheal intubation, but it was reappeared after extubation. However, anesthetic induction with self-respiration and gentle assistance with manual bagging led to a successful intubation. This case was explained by hydromechanics in a collapsible premature airway.

Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism? / 대한구급학회지

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Suspected Pulmonary Embolism during Hickman Catheterization in a Child: What Else Should Be Considered besides Pulmonary Embolism? / 대한중환자의학회지

A 16-month-old girl with acute lymphoblastic leukemia expired during Hickman catheter insertion. She had undergone chemoport insertion of the left subclavian vein six months earlier and received five cycles of chemotherapy. Due to malfunction of the chemoport and the consideration of hematopoietic stem cell transplantation, insertion of a Hickmann catheter on the right side and removal of the malfunctioning chemoport were planned under general anesthesia. The surgery was uneventful during catheter insertion, but the patient experienced the sudden onset of pulseless electrical activity just after saline was flushed through the newly inserted catheter. Cardiopulmonary resuscitation was commenced aggressively, but the patient was refractory. Migration of a thrombus generated by the previous central catheter to the pulmonary circulation was suspected, resulting in a pulmonary embolism.

Anaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus: A case report

Anaphylaxis is a type I allergic reaction and its clinical features occur after re-exposure to the same allergen. Numerous types of drugs can cause anaphylaxis during general anesthesia. Topical bovine thrombin (TBT) is usually used for hemostasis during surgery. However, TBT can cause interruption of the normal blood coagulation pathways, delay wound repair, and lead to uncontrolled bleeding, anaphylaxis, or death. Anaphylaxis caused by TBT during the perioperative period is very rare. We report the case of a patient who developed severe hypotension, tachycardia, and bronchospasm while undergoing discectomy for herniated nucleus pulposus. Based on the symptoms and signs, anaphylaxis was considered most likely. Identification of the causative agents is important in these cases because it can be very helpful for the management and prevention of anaphylaxis.

Unusual excessive sweating and hypothermia during hysterectomy under general anesthesia: A case report

A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3degrees C. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications.

Tension pneumothorax during tracheoesophageal fistula repair: A case report

Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.

Inhibitory Effect of Cordyceps Militaris Water Extracts on Sarcoma-180 Cell-Induced Ascities Tumor in ICR Mice

This study was undertaken to evaluate the antitumor activities of Cordyceps militaris of silkworm pupa (CMP) and silkworm larva (CML), as compared with the effect of cordycepin, an active compound found in Cordyceps militaris. Antiproliferation effect of the test materials were evaluated in the sarcoma-180 cells using the MTT test. For the in vivo study, ICR mice were inoculated i.p. with 1.0 X 10(6) sarcoma-180 cells/mouse on Day 0, and were again i.p. injected with one of the following substances from Day 1 to Day 10 : saline (control group), 50 mg/kg (CMP50, CML50) ,100 ma/kg (CMP100, CML100), or 200 mg/kg (CMP200, CML200) of Cordyceps militaris water extracts, or 1 mg/kg (C1), 2 mg/kg (C2), or 4 mg/kg (C4) of cordycepin. Pretreatment of the sarcoma-180 cells with 100 mg/ml, 500 mg/ml, and 1000 mg/ml of CML (60.1+/-2.5%, 49.8+/-3.7%, and 45.4+/-0.1% of the value for untreated control cells, respectively) or CMP (68.3+/-2.1%, 55.1+/-0.9%, and 51.4+/-3.5% of the value for control cells, respectively) for 48 hrs significantly decreased the survival rate (proliferation) of tumor cells (p<0.05). Body weight of the control mice bearing ascites tumor and injected with saline was 1.4 times of the value for normal animals at day 18. Mice bearing ascites tumor and injected with cordycepin (1, 2, or 4 mg/kg) exhibited a significantly lighter body weight compared with the control mice, while animals injected with CMP or CML (50, 100, or 200 mg/kg) showed a significantly lighter body weight compared with the mice injected with cordycepin. Mice injected with CMP50, CMP100, or CMP200 mg/kg (or CML50, CML100, or CML200 mg/kg) showed a 133% (or 90%), 80% (or 62%), and 68% (or 52%) longer mean survival time, and those treated with C1, C2, or C4 exhibited a 54%, 91% and 80% longer survival time compared to the value for control mice injected with saline. These results indicate that the hot-water extracts of Cordyceps militaris of both silkworm pupa and silkworm larva have an anti-proliferation effect of tumor cells as well as the life prolongation effect in mice bearing ascites tumor, which are superior to the activities of cordycepin.